A provincial election and talk of tariffs have taken up much of Ontario’s attention recently but we shouldn’t lose sight of that other problem: health care. Tariffs may or may not happen, but our health-care challenges remain. As well as severe understaffing that leads to longer wait times and 2.5 million Ontarians without a family physician, we now have no clear direction on cancer.
Provinces generally release multi-year cancer plans to guide their work in prevention, treatment and care. A good plan is a roadmap: it talks about funding, describes what it will focus on, how it will measure changes, tells us who is responsible for keeping us on course and how treatment and services can continue during a state of emergency.
The recently released and much delayed Ontario cancer action plan is like reading a map without the big red YOU ARE HERE sticker.
For those of us who live with cancer, are caregivers, help patients or do research and innovation, this plan is supposed to give us clarity and confidence on the future of cancer care. Instead, we have a 27-page document that is heavy on the successes of the last plan and light on outlining the specific commitments and measures that will define the next four years. Normally, it would be a five-year plan but this one was delayed.
Structured with aspirational, nebulous goals, it lacks clear actions and performance metrics. It also leaves us with important questions: Where is the funding that will support these objectives? How will this plan be held to account?
Yes, some mention is made of a robust measurement plan. Performance indicators are operating somewhere in the background, but no specific details are shared, and it’s not made clear if they ever will be shared in a timely and transparent manner.
Instead, the plan commits to publicly reporting provincial results through Ontario Health’s annual report, through cancer screening performance reports and through Ontario’s Cancer System Quality Index. But some of the reports have not been updated since 2023 and feature even older data, making it challenging to even determine an appropriate baseline.
Quebec’s cancer plan, constructed with input from health-care providers and patient groups, has key actions connected to goals – all of which relies on modernizing the data. This effort includes updating the Quebec Cancer Registry, which is crucial to monitoring progress on the plan and adjusting policy.
Or consider British Columbia’s plan released in February 2023. Some 16 months later, BC Cancer posted 20 metrics such as hiring 92 more cancer-care physicians and distributing almost 30,000 HPV self-screening kits for a first-in-Canada screen at-home program. These are clear metrics that track progress.
Meanwhile, back in Ontario, the province’s plan lays out valuable, patient-centered goals but too often supports them with fuzzy commitments to “continue to build,” and “work to strengthen” as key actions.
While still vague, the plan’s strategic objective to implement a streamlined approach for timely adoption of innovation and technologies has our attention. This could help patients with faster access to innovative medicines as much for diagnostics as for treatment. Take the example of the biomarker test. It could take anywhere from 10 days to several weeks for the results. Delayed test results can delay diagnosis, which can delay treatment, leading to a worse outcome.
But while the plan talks about access to diagnostics in its goal to create seamless and effective integration of cancer services, it doesn’t go much deeper into it. Just that Ontario has made significant efforts to improve access to diagnostics and expedited follow-up. That’s where it ends. Where’s the metric, much less the commitment?
Ontario has long been a leader in cancer care. It has the highest cancer survival rate in the country. For the past 20 years, multi-year provincial cancer plans have ably guided change in our cancer system. Thousands more lives were saved each year by improving how we prevent, diagnose and treat cancer.
Cancer plans should be more than aspirational. They are the strategic framework that focuses our efforts. And in a disease characterized by insidious uncertainty, a cancer plan can provide a version of certainty. A sense that things can be better.
If Ontario’s newest plan doesn’t have the robust metrics and data pieces of its predecessors, or even of other jurisdictions, patients could be at risk. And Ontarians won’t know if we are headed in the right direction in cancer care.
